Outcome analysis for adults with spondylolisthesis treated with posterolateral fusion and transpedicular screw fixation

The outcomes of 52 adult patients with symptomatic low-grade spondylolisthesis treated with autologous posterolateral arthrodesis and pedicle screw fixation were retrospectively reviewed. Although a 90% rate of successful fusion was obtained using this technique, only 60% of patients were considered to have good outcomes. Treatment failures consisted mostly of back pain and were not predicted by preoperative symptoms. Compensation claims and smoking had very significant adverse impacts on both employment and pain results despite high fusion rates, particularly in patients under the age of 55 years. Overall, patients who required more than one operation demonstrated poor outcomes compared to those who only needed one. However, patients with at least two prior operations or preoperative pseudoarthrosis fared particularly poorly, whereas those who had undergone only one prior surgery and had no attendant compensation issue reported good results. A trend toward poor outcome was observed in patients with postlaminectomy spondylolisthesis, versus those with isthmic or degenerative etiologies. Gender did not exert an impact on outcome. The authors conclude that autologous posterolateral arthrodesis combined with pedicle screw fixation resulted in a high fusion rate, and contributed to successful outcomes in the treatment of certain subgroups of adults with spondylolisthesis. In the absence of other risk factors, patients may obtain significant benefit from surgery despite older age and a single failed operation. Careful patient selection appears critical in predicting the maximum benefit from this technique.